Healthcare Provider Details

I. General information

NPI: 1922319599
Provider Name (Legal Business Name): BART WADE KIMBRELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BART KIMBRELL M.D.

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ACADEMY STREET
GAINESVILLE GA
30501
US

IV. Provider business mailing address

700 WILMINGTON ISLAND RD APT 503
SAVANNAH GA
31410-4532
US

V. Phone/Fax

Practice location:
  • Phone: 770-282-8820
  • Fax:
Mailing address:
  • Phone: 770-540-5497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number66961
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101288054
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: